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The Sensitivity and Costs of Testing for SARS-CoV-2 Infection With Saliva Versus Nasopharyngeal Swabs : A Systematic Review and Meta-analysis.
Bastos, Mayara Lisboa; Perlman-Arrow, Sara; Menzies, Dick; Campbell, Jonathon R.
  • Bastos ML; McGill University and McGill International TB Centre, Montreal, Quebec, Canada, and State University of Rio de Janeiro, Rio de Janeiro, Brazil (M.L.B.).
  • Perlman-Arrow S; McGill University, Montreal, Quebec, Canada (S.P.).
  • Menzies D; McGill University, McGill International TB Centre, and Montreal Chest Institute, Montreal, Quebec, Canada (D.M.).
  • Campbell JR; McGill University and McGill International TB Centre, Montreal, Quebec, Canada (J.R.C.).
Ann Intern Med ; 174(4): 501-510, 2021 04.
Article in English | MEDLINE | ID: covidwho-1202203
ABSTRACT

BACKGROUND:

Nasopharyngeal swabs are the primary sampling method used for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but they require a trained health care professional and extensive personal protective equipment.

PURPOSE:

To determine the difference in sensitivity for SARS-CoV-2 detection between nasopharyngeal swabs and saliva and estimate the incremental cost per additional SARS-CoV-2 infection detected with nasopharyngeal swabs. DATA SOURCES Embase, Medline, medRxiv, and bioRxiv were searched from 1 January to 1 November 2020. Cost inputs were from nationally representative sources in Canada and were converted to 2020 U.S. dollars. STUDY SELECTION Studies including at least 5 paired nasopharyngeal swab and saliva samples and reporting diagnostic accuracy for SARS-CoV-2 detection. DATA EXTRACTION Data were independently extracted using standardized forms, and study quality was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2). DATA

SYNTHESIS:

Thirty-seven studies with 7332 paired samples were included. Against a reference standard of a positive result on either sample, the sensitivity of saliva was 3.4 percentage points lower (95% CI, 9.9 percentage points lower to 3.1 percentage points higher) than that of nasopharyngeal swabs. Among persons with previously confirmed SARS-CoV-2 infection, saliva's sensitivity was 1.5 percentage points higher (CI, 7.3 percentage points lower to 10.3 percentage points higher) than that of nasopharyngeal swabs. Among persons without a previous SARS-CoV-2 diagnosis, saliva was 7.9 percentage points less (CI, 14.7 percentage points less to 0.8 percentage point more) sensitive. In this subgroup, if testing 100 000 persons with a SARS-CoV-2 prevalence of 1%, nasopharyngeal swabs would detect 79 more (95% uncertainty interval, 5 fewer to 166 more) persons with SARS-CoV-2 than saliva, but with an incremental cost per additional infection detected of $8093.

LIMITATION:

The reference standard was imperfect, and saliva collection procedures varied.

CONCLUSION:

Saliva sampling seems to be a similarly sensitive and less costly alternative that could replace nasopharyngeal swabs for collection of clinical samples for SARS-CoV-2 testing. PRIMARY FUNDING SOURCE McGill Interdisciplinary Initiative in Infection and Immunity. (PROSPERO CRD42020203415).
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Saliva / Nasopharynx / COVID-19 Testing / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Ann Intern Med Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Saliva / Nasopharynx / COVID-19 Testing / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Ann Intern Med Year: 2021 Document Type: Article